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Blog Post · August 29, 2023

Access to Mental Health Providers Is Highly Uneven Across the State

photo - Counselor Listens to Young Adult

Mental health services are a pervasive and growing need for a large number of Californians. Nearly one third of the state’s adults recently reported that they are struggling with anxiety and depression; reports of serious psychological distress rose markedly between 2016 and 2020. As the need for services increases, California’s mental health workforce is falling behind.

The lack of mental health providers—including psychologists, licensed clinical social workers, marriage and family therapists—is a long-standing problem in California. While this group of professionals isn’t able to prescribe medications—that’s usually done by a psychiatrist or primary care physician—they comprise the vast majority of California’s licensed providers. They are also often the clinicians deployed by health plans to provide therapy, including to those who are insured by Medi-Cal.

California has about 121,000 psychologists, clinical social workers and marriage and family therapists with a current state license, according to the most recent data available. The map below shows their distribution across California. As is the case with physicians, there are higher shares of providers in coastal, urban counties—especially the Bay Area—relative to county population. This stands in stark contrast to several, smaller counties in the northern regions of the state as well as larger counties in the Central Valley, including San Joaquin and Kern, that have less than half as many mental health providers than counties like San Francisco, Alameda, and Santa Cruz do. Larger Southern California counties, including Los Angeles and San Diego, also boast relatively higher shares of these providers.

It’s important to note that these numbers most likely overestimate the supply of mental health providers available, since we don’t know if these providers 1) accept insurance and 2) are accepting new clients.

Unfortunately, we do not have good sources of information to answer these questions. The state’s new health payment database—being compiled by the Department of Health Care Access and Information—will eventually allow for more in-depth examinations of access to mental health services. But this database will only include providers who accept insurance coverage.

Meanwhile, California has been investing in training and pipeline programs to increase the state’s supply of these much-needed providers. And the shift to telehealth during the pandemic was especially pronounced for mental health visits—this shift could help solve some of the unequal distribution of providers across different regions of the state.

But navigating the complicated process of finding a therapist and paying for services undoubtedly remains a challenge for many Californians. And while the governor continues to push for changes to how state funding for mental health services is targeted, addressing the long-standing and stark regional differences in mental health providers needs to be a priority.


Health & Safety Net Higher Education mental health telehealth Workforce Needs